Total hip arthroplasty in adolescent patients delivers large improvements in hip function and quality of life : a single-centre cohort study with up to 34 years of follow-up.

Abstract

The aim of this study was to report the implant survival, quality of life, and patient-reported outcome measures (PROMs) in a cohort of adolescent patients who underwent total hip arthroplasty (THA). This was retrospective review of all adolescent patients treated with THA in a single centre. Survival was estimated using the Kaplan-Meier method. Hip-specific PROMs included the Oxford Hip Score (OHS) and the modified Harris Hip Score (mHHS). Health-related quality of life was recorded using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L) and a subjective health assessment using a visual analogue scale. A total of 68 THAs were undertaken in 49 patients with a median age of 16 years (IQR 10 to 19), between April 1971 and April 2023. The median follow-up for the assessment of survival in the whole cohort was 4.6 years (IQR 1.4 to 8.9). The cumulative incidence of revision was 10.0% (95% CI 0.0 to 20.8) at ten years, 29.1% (95% CI 4.1 to 47.5) at 15 years, 36.2% (95% CI 8.0 to 55.7) at 20 years, and 45.3% (95% CI 12.1 to 65.9) at 30 years. The mean index value derived from the EQ-5D-3L, which was available in 15 patients (21 THAs), improved from -0.35 (SD 0.28) to 0.71 (SD 0.33) at a median follow-up of 1.5 years (IQR 0.5 to 2.0). The median OHS improved from 10 (IQR 7 to 16) preoperatively to 45 (IQR 37 to 48), and the median mHHS improved from 28 (IQR 16.25 to 32.75) to 84 (IQR 63 to 91), at a median follow-up of 1.3 years (IQR 0.5 to 2.3). Adolescent patients with severe symptoms from the hip have some of the worst possible states of health which are encountered in orthopaedic surgery. THA is an effective form of treatment for hip conditions in children, with a higher than normal incidence of revision surgery. The socioeconomic benefits of THA need further investigation to establish guidelines for the treatment of children with severe symptoms from the hip.